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Nancy S. Rotter, PhD, a pediatric psychologist in the Food Allergy Center at Massachusetts General Hospital, treats children who are impacted by medical illness and specializes in understanding the challenges of preparing allergic children for transitions at different developmental stages. Sarah Wolfgang talks about her own experience managing her day to day activities with her two allergic children.

Both my two year old and four year old are allergic to multiple foods. Both will be attending a new school in the fall, which raises many questions. To gain insight, I spoke with Nancy S. Rotter, PhD, a pediatric psychologist in the Food Allergy Center at Massachusetts General Hospital. Dr. Rotter studies the impact of medical illness on children and specializes in understanding the challenges of preparing allergic children for transitions at different developmental stages.

Planning for preschool, which may be one of the first times that children are away from home, can be an anxiety-provoking time. Dr. Rotter explains that we need to teach our children and prepare them in a developmentally appropriate way. At ages three and four, children are literal and concrete thinkers, but they also engage in magical thinking. For example, they may believe that the tooth fairy exists. In addition, their concrete thinking may also lead them to find cause and effect relationships that do not exist. For example, a dairy allergic child may believe her ice cream eating cousin does not love her.

Dr. Rotter’s tips for when your child becomes a young child

Use creative or clear language to help identify the food your child may eat safely.

Refer to foods with their actual titles to help your child identify what they can consume. For example, if your child is allergic to dairy and cannot consume milk, call milk “soy milk” or “rice milk.” Use creative titles, such as “Johnny’s special bread. My son has a wheat allergy, among other things, and I give him “Miles’ special pretzels” and “corn, rice or quinoa pasta.” Explain to the child that his or her version is different than the one he or she may see at school or elsewhere. In addition, Dr. Rotter coaches parents to explain to their children that this allergy-friendly or “special” food is what they need to keep their bodies healthy.

Be consistent and model safe behavior.

Read labels in front of your child. Don’t share food, plates or utensils. Teach your child not to eat off the floor or the table. You may be tempted to share, especially when everyone is eating safe snacks or meals, but the more consistently you apply food allergy safety rules, the more your children will follow them automatically.

Educate your friends, family and other caregivers.

It is vital that everyone understand the rules. At times, this may prove more challenging than others, and a future issue of this newsletter will cover this topic in greater detail.

Create non-food rituals.

Replace food treats and activities with arts and crafts, stickers, walks and other experiences that will be special for your children. Until you figure out what feels special to you and your family, you may find replacement rituals painful and need to grieve the loss of your pre-allergy diagnosis vision of child-rearing, but you will experience fun again. (For example, we hosted a sticker-filled egg hunt for Easter with plastic eggs.)

Acknowledge and appreciate the extra work it takes to keep your child safe.

By doing so, you are partnering with the teachers, caregivers, waiters, cooks, friends, family and others who work with you to keep your child safe. “It’s really important,” says Dr. Rotter, “to acknowledge that your child's teacher is managing lots of different needs in the classroom, and that your child's food allergies may require extra effort. Teachers are appreciative when parents recognize and thank them for attending to their children's needs.”

Meet with staff at your child’s school.

Learn how the school manages food and the procedures used to keep your child safe. Make sure that eating and drinking are supervised, with regular hand and surface washing. Find out if certain foods are excluded and/or if additional measures need to be taken (your doctor will help you determine your child’s level of risk). Walk through the Food Allergy Action Plan from the Food Allergy Center. Make sure all substitute teachers are educated about food allergic children. And, again, acknowledge their attention to you and thank them.

Teach your children about their food allergies.

Although society is adapting to food allergies, the world is not going to fully adjust to their particular needs. They must be able to tell people about their allergies and know what to do if they have a serious reaction.

Don’t be surprised if you experience some awkward moments as you first negotiate the allergen-filled world with your child or children. I have wished for a do-over more than once. I have found that simply stating, “I’m sorry I’m learning how to unwrap the bubble wrap on my allergic children” or words to that effect go a long way to easing awkwardness. Your listeners will understand — all parents struggle at some point with how much to protect their children.

If you have any questions about how best to transition your children, please do not hesitate to contact Dr. Rotter or others on the Food Allergy team. They are here to help.